Pancreatic adenocarcinoma: A review of recent paradigms and advances in epidemiology, clinical diagnosis and management

Pancreatic cancer is one of the dreaded malignancies for both the patient and the clinician.The five-year survival rate of pancreatic adenocarcinoma(PDA)is as low as 2%despite multimodality treatment even in the best hands.As per the Global Cancer Observatory of the International Agency for Research in Cancer estimates of pancreatic cancer,by 2040,a 61.7%increase is expected in the total number of cases globally.With the widespread availability of next-generation sequencing,the entire genome of the tumors is being sequenced regularly,providing insight into their pathogenesis.As invasive PDA arises from pancreatic intraepithelial neoplasia and mucinous neoplasm and intraductal papillary neoplasm,screening for them can be beneficial as the disease is curable with resection at an early stage.Routine preoperative biliary drainage has no role in patients suffering from PDA with obstructive jaundice.If performed,metallic stents are preferred over plastic ones.Minimally invasive procedures are preferred to open procedures as they have less morbidity.The duct-to-mucosa technique for pancreaticojejunostomy is presently widely practiced.The role of intraperitoneal drains after surgery for PDA is controversial.Neoadjuvant chemoradiotherapy has been proven to have a significant role both in locally advanced as well as in resectable PDA.Many new regimens and drugs have been added in the arsenal of chemoradiotherapy for metastatic disease.The roles of immunotherapy and gene therapy in PDA are being investigated.This review article is intended to improve the understanding of the readers with respect to the latest updates of PDA,which may help to trigger new research ideas and make better management decisions.

Radiological review of rhinocerebral mucormycosis cases during the COVID-19 Pandemic: A single-center experience

Mucormycosis is caused by the fungi belonging to the order Mucorales and class Zygomycetes.The incidence of mucormycosis has increased with the onset of the severe acute respiratory syndrome coronavirus 2 infections leading to the coronavirus disease 2019(COVID-19)pandemic.This rise is attributed to the use of immunosuppressive medication to treat COVID-19 infections.Authors have retrospectively collected data of our cases of mucormycosis diagnosed from April 2020 to April 2021 at our institute.A total of 20 patients with rhinocerebral mucormycosis were studied.Most of the study subjects were male patients(90%)and were of the age group 41-50 years.Most patients in the review had comorbidities(85%)with diabetes being the most common comorbidity.Para nasal sinuses were involved in all the cases.Involvement of the neck spaces was present in 60%of the cases.Involvement of the central nervous system was present in 80%of the cases.Orbital involvement was present in 90%of the cases.The authors reviewed the various imaging findings of mucormycosis on computed tomography and magnetic resonance imaging in this article.

Role of optical coherence tomography in Barrett’s esophagus

Traditional endoscopic techniques for Barrett’s esophagus(BE)surveillance relied on factor of probability as endoscopists performed cumbersome random biopsies of low yield.Optical coherence tomography(OCT)is a novel technique based on tissue light interference and is set to break conventional barriers.OCT was initially introduced in ophthalmology but was soon adopted by other areas of medicine.When applied to endoscopy,OCT can render images of the superficial layers of the gastrointestinal tract and is highly sensitive in detecting dysplasia in BE.Volumetric laser endomicroscopy is a second generation OCT endoscope device which is able to identify buried glands after ablation.Addition of artificial intelligence to OCT has rendered it more productive.The newer additions to OCT such as angiogram and laser marking will increase the accuracy of investigation.In spite of the few inevitable drawbacks associated with the technology,it presently outperforms all newer endoscopic techniques for the surveillance of BE.